=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861442956
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BROWARD MEDICAL PHYSICIAN ASSOCIATES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2006
-----------------------------------------------------
Last Update Date | 12/10/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 601 N FLAMINGO RD 306
-----------------------------------------------------
City | PEMBROKE PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33028-1015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-436-1131
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 601 N FLAMINGO RD SUITE 306
-----------------------------------------------------
City | PEMBROKE PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33028-1015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-436-1131
-----------------------------------------------------
Fax | 954-436-2864
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRES
-----------------------------------------------------
Name | DR. JORGE G DIAZ
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 954-436-1131
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 0061870
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------